National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0995 Att 28 STD Tx Guidelines Short Long-Term Evaluation -Screenshot	Form and Instruction	New	Available
Form 0920-0995 Att 27 STD Tx Guidelines Short Long-Term Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 26 STD Tx Guidelines Short Post-Course Evaluation -Screenshot	Form and Instruction	New	Available
Form 0920-0995 Att 25 STD Tx Guidelines Short Post-Course Evaluation wordversion	Form	New	Available
Form 0920-0995 Att 23 STD Tx Guidelines Complete Long-Term Evaluation wordversion	Form	New	Available
Form 0920-0995 Att 24 STD Tx Guidelines Complete Long-Term Evaluation -Screenshot	Form and Instruction	New	Available
Form 0920-0995 Att 21 STD Tx Guidelines Complete Post-Course Evaluation wordversion	Form	New	Available
Form 0920-0995 Att 22 STD Tx Guidelines Complete LongTerm Evaluation - Screenshot	Form and Instruction	New	Available
Form 0920-0995 Att 20 Wet Mount Long Term Evaluation -Screenshot	Form	New	Available
Form 0920-0995 Att 19 Wet Mount Long-Term wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 18 Wet Mount Post-Course Evaluation -Screenshot	Form	New	Available
Form 0920-0995 Att 17 Wet Mount Post-Course Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 16 Practicum 3-month Long-Term Evaluation -Screenshot	Form	New	Available
Form 0920-0995 Att 15 Practicum Long-Term Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 14 Practicum Post-Course Evaluation -Screenshot	Form	New	Available
Form 0920-0995 Att 13 Practicum Post-Course Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 12 Intensive Didactic Long-Term Evaluation -Screenshot	Form and Instruction	New	Available
Form 0920-0995 Att 11 Intensive Didactic Long-Term Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 10 Intensive Didactic Post-Course Evaluation – Screenshot	Form and Instruction	New	Available
Form 0920-0995 Att 9 Intensive Didactic Post-Course Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 8 Intensive Complete Long-Term Evaluation -Screenshot	Form	New	Available
Form 0920-0995 Att 7 Intensive Complete Long-Term Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 6 Intensive Complete Post-Course Evaluation -Screenshot	Form	New	Available
Form 0920-0995 Att 5 Intensive Complete Post-Course Evaluation wordversion	Form and Instruction	New	Available
Form 0920-0995 Att 4 Abbreiviated HPAT Screenshot	Form and Instruction	Modified	Available
Form 0920-0995 Att 3 NNPTC Abbreviated HPAT wordversion	Form and Instruction	Modified	Available
SupSta A.docx	Supporting Statement A	Uploaded 2017-02-22	Available
Att 38 Table with Description of Attachments.docx	Supplementary Document	Uploaded 2017-02-21	Available
Att 37 Project Determination.pdf	Supplementary Document	Uploaded 2017-02-21	Available
Att 30 Basic Post-Course Evaluation -Screenshot.pdf	Supplementary Document	Uploaded 2017-02-21	Available
Att 29 Basic Post-Course Evaluation wordversion.docx	Supplementary Document	Uploaded 2017-02-21	Available
Att 3A Previously Approved HPAT- wordversion Trackchange.docx	Supplementary Document	Uploaded 2017-02-21	Available
Att 3 NNPTC Abbreviated HPAT wordversion.docx	Supplementary Document	Uploaded 2017-02-21	Available
Att 1 Authorizing Legislation Section 301 PHSA.docx	Supplementary Document	Uploaded 2017-02-21	Available
SupSta B.doc	Supporting Statement B	Uploaded 2017-02-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
225770	3 Month Long-Term Email Invitation	Instruction	New
225769	Immediate Post-Course Email Invitation	Instruction	New
225768	Basic Long-Term Evaluation	Instruction	New
225767	Short Guidelines Long-Term Evaluation	Form and Instruction	New	Att 28 STD Tx Guidelines Short Long-Term Evaluation -Screenshot
225767	Short Guidelines Long-Term Evaluation	Form and Instruction	New	Att 27 STD Tx Guidelines Short Long-Term Evaluation wordversion
225766	Short Guidelines Post-Course Evaluation	Form and Instruction	New	Att 26 STD Tx Guidelines Short Post-Course Evaluation -Screenshot
225766	Short Guidelines Post-Course Evaluation	Form	New	Att 25 STD Tx Guidelines Short Post-Course Evaluation wordversion
225765	STD Treatment Guidelines Complete Long-Term Evaluation	Form	New	Att 23 STD Tx Guidelines Complete Long-Term Evaluation wordversion
225765	STD Treatment Guidelines Complete Long-Term Evaluation	Form and Instruction	New	Att 24 STD Tx Guidelines Complete Long-Term Evaluation -Screenshot
225764	STD Treatment Guidelines Complete Post -Course Evaluation	Form	New	Att 21 STD Tx Guidelines Complete Post-Course Evaluation wordversion
225764	STD Treatment Guidelines Complete Post -Course Evaluation	Form and Instruction	New	Att 22 STD Tx Guidelines Complete LongTerm Evaluation - Screenshot
225763	Wet Mount Long-Term Evaluation	Form	New	Att 20 Wet Mount Long Term Evaluation -Screenshot
225763	Wet Mount Long-Term Evaluation	Form and Instruction	New	Att 19 Wet Mount Long-Term wordversion
225762	wet Mount Posst-Course Evaluation	Form	New	Att 18 Wet Mount Post-Course Evaluation -Screenshot
225762	wet Mount Posst-Course Evaluation	Form and Instruction	New	Att 17 Wet Mount Post-Course Evaluation wordversion
225748	Practicum Long-Term Evaluation	Form	New	Att 16 Practicum 3-month Long-Term Evaluation -Screenshot
225748	Practicum Long-Term Evaluation	Form and Instruction	New	Att 15 Practicum Long-Term Evaluation wordversion
225747	Practicum Post-Course Evaluation	Form	New	Att 14 Practicum Post-Course Evaluation -Screenshot
225747	Practicum Post-Course Evaluation	Form and Instruction	New	Att 13 Practicum Post-Course Evaluation wordversion
225745	Intensive-Didactic Long-Term Evaluation	Form and Instruction	New	Att 12 Intensive Didactic Long-Term Evaluation -Screenshot
225745	Intensive-Didactic Long-Term Evaluation	Form and Instruction	New	Att 11 Intensive Didactic Long-Term Evaluation wordversion
225742	Intensive-Didactic Post Course Evaluation	Form and Instruction	New	Att 10 Intensive Didactic Post-Course Evaluation – Screenshot
225742	Intensive-Didactic Post Course Evaluation	Form and Instruction	New	Att 9 Intensive Didactic Post-Course Evaluation wordversion
225741	Intensive Complete Long-Term Evaluation	Form	New	Att 8 Intensive Complete Long-Term Evaluation -Screenshot
225741	Intensive Complete Long-Term Evaluation	Form and Instruction	New	Att 7 Intensive Complete Long-Term Evaluation wordversion
225738	Intensive Complete Post-Couse Evaluation	Form	New	Att 6 Intensive Complete Post-Course Evaluation -Screenshot
225738	Intensive Complete Post-Couse Evaluation	Form and Instruction	New	Att 5 Intensive Complete Post-Course Evaluation wordversion
208451	NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	Form and Instruction	Modified	Att 4 Abbreiviated HPAT Screenshot
208451	NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	Form and Instruction	Modified	Att 3 NNPTC Abbreviated HPAT wordversion

ICR Details

OMB Control No: 0920-0995	ICR Reference No: 201702-0920-011
Status: Historical Active	Previous ICR Reference No: 201309-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 20457
Title: National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/22/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/22/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved
Responses	7,152	0	0
Time Burden (Hours)	423	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this data collection is to support program management of the National Network of Sexually Transmitted Disease Clinical Prevention Training Center (NNPTC) and to evaluate the reach and impact of the NNPTC's training activities.

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Authorizing Statute(s): PL: Pub.L. 42 - 792 776 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 48805	07/26/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 9745	02/08/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 16

table that charts list of burden

IC Title	Form No.	Form Name
3 Month Long-Term Email Invitation
Basic Long-Term Evaluation
Immediate Post-Course Email Invitation
Intensive Complete Long-Term Evaluation	0920-0995, 0920-0995	Att 7 Intensive Complete Long-Term Evaluation wordversion ,   Att 8 Intensive Complete Long-Term Evaluation -Screenshot
Intensive Complete Post-Couse Evaluation	0920-0995, 0920-0995	Att 5 Intensive Complete Post-Course Evaluation wordversion ,   Att 6 Intensive Complete Post-Course Evaluation -Screenshot
Intensive-Didactic Long-Term Evaluation	0920-0995, 0920-0995	Att 11 Intensive Didactic Long-Term Evaluation wordversion ,   Att 12 Intensive Didactic Long-Term Evaluation -Screenshot
Intensive-Didactic Post Course Evaluation	0920-0995, 0920-0995	Att 9 Intensive Didactic Post-Course Evaluation wordversion ,   Att 10 Intensive Didactic Post-Course Evaluation – Screenshot
NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	0920-0995, 0920-0995	Att 3 NNPTC Abbreviated HPAT wordversion ,   Att 4 Abbreiviated HPAT Screenshot
Practicum Long-Term Evaluation	0920-0995, 0920-0995	Att 15 Practicum Long-Term Evaluation wordversion ,   Att 16 Practicum 3-month Long-Term Evaluation -Screenshot
Practicum Post-Course Evaluation	0920-0995, 0920-0995	Att 13 Practicum Post-Course Evaluation wordversion ,   Att 14 Practicum Post-Course Evaluation -Screenshot
STD Treatment Guidelines Complete Long-Term Evaluation	0920-0995, 0920-0995	Att 24 STD Tx Guidelines Complete Long-Term Evaluation -Screenshot ,   Att 23 STD Tx Guidelines Complete Long-Term Evaluation wordversion
STD Treatment Guidelines Complete Post -Course Evaluation	0920-0995, 0920-0995	Att 22 STD Tx Guidelines Complete LongTerm Evaluation - Screenshot ,   Att 21 STD Tx Guidelines Complete Post-Course Evaluation wordversion
Short Guidelines Long-Term Evaluation	0920-0995, 0920-0995	Att 27 STD Tx Guidelines Short Long-Term Evaluation wordversion ,   Att 28 STD Tx Guidelines Short Long-Term Evaluation -Screenshot
Short Guidelines Post-Course Evaluation	0920-0995, 0920-0995	Att 25 STD Tx Guidelines Short Post-Course Evaluation wordversion ,   Att 26 STD Tx Guidelines Short Post-Course Evaluation -Screenshot
Wet Mount Long-Term Evaluation	0920-0995, 0920-0995	Att 19 Wet Mount Long-Term wordversion ,   Att 20 Wet Mount Long Term Evaluation -Screenshot
wet Mount Posst-Course Evaluation	0920-0995, 0920-0995	Att 17 Wet Mount Post-Course Evaluation wordversion ,   Att 18 Wet Mount Post-Course Evaluation -Screenshot

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,152	0	0	7,152	0	0
Annual Time Burden (Hours)	423	0	0	423	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This revision request consists of changing the title to “National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC): Evaluation” and adding 14 additional collection instruments.

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Annual Cost to Federal Government: $102,700

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/22/2017

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